Late onset insomnia icd 1012/1/2023 ![]() ![]() Therefore, we aimed to identify independent risk factors contributing to the development of LOS in preterm born infants in a multicenter case-control study with an overview of the clinical characteristics of patients with LOS within the first month of life. Identification of independent risk factors for LOS in preterm infants may allow selection of infants at an increased risk and the development of novel, personalized therapeutic strategies aimed at reducing the LOS incidence. However, most of these studies are characterized by a small number of cases, retrospective and single-center study designs, and the absence of detailed (daily) clinical data, limiting the possibility of adequate matching with controls and thus the ability to draw firm conclusions. In addition, breastmilk feeding within the first month of life has been shown to be protective against LOS development. Several studies have identified risk factors for LOS, including a lower birth weight, gestational age (GA), and the presence of central venous catheters. In addition, screening of bodily fluids (e.g., blood and urine) may also require an invasive procedure, increasing the risk for LOS independently. The gold standard for diagnosis is confirmation of a pathogen in the blood culture, which is limited by suboptimal sensitivity and delay of a definite diagnosis because of the turnaround time to become positive. The diagnosis of LOS in daily clinical practice may be challenging, especially in preterm infants, as clinical symptoms have limited sensitivity and specificity. Survivors are at risk for prolonged hospitalization, development of necrotizing enterocolitis (NEC), bronchopulmonary dysplasia, and neurodevelopmental impairment. The incidence rates for LOS in preterm infants vary between 20 and 38% in the first 120 days of life, and mortality rates range from 13 to 19%. Late-onset sepsis (LOS), defined as sepsis onset after 72 h of life, is a leading cause of mortality in the neonatal intensive care unit (NICU). A rapid advancement of enteral feeding, preferably with breastmilk, may proportionally reduce the number of parenteral feeding days and consequently the risk for LOS. Conclusion: The length of parenteral feeding was associated with LOS, whereas breastmilk administration was protective against CoNS-LOS. Formula feeding was an independent risk factor for development of CoNS-LOS (OR = 3.779 95% CI 1.257–11.363 p = 0.018). Specifically cephalosporins administration prior to clinical onset was inversely related to coagulase-negative staphylococcus LOS (CoNS-LOS) development. These findings could largely be attributed to specific LOS-causative pathogens, since these predictive factors could be identified for gram-positive, but not for gram-negative, LOS cases. In the case-control cohort, every additional day of parenteral feeding increased the risk for LOS (adjusted OR = 1.29 95% CI 1.07–1.55 p = 0.006), whereas antibiotics administration decreased this risk (OR = 0.08 95% CI 0.01–0.88 p = 0.039). Results: In total, 755 infants were included, including 194 LOS cases (41 gram-negative cases, 152 gram-positive cases, and 1 fungus). Clinical and demographic risk factors were identified using univariate and multivariate regression analyses in a 1: 1 matched case-control cohort. Detailed demographical and clinical data were collected daily up to day 28 postnatally. Methods: In this multicenter case-control study, preterm infants born at ≤30 weeks of gestation were included at 9 neonatal intensive care units. ![]() Objectives: The aim was to identify risk factors for LOS. Identification of risk factors could allow selection of infants at an increased risk for LOS. Timely recognition and initiation of antibiotics are important factors for improved outcomes. Background: Late-onset sepsis (LOS) in preterm infants is a leading cause of mortality and morbidity. ![]()
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